Abstract 213: Near-term Functional Status and Cardiovascular Medication Use Before and After Coronary Computed Tomographic Angiography
Background: Cardiac computed tomographic angiography (CCTA) is increasingly utilized for diagnosis of coronary artery disease (CAD). The impact of CCTA upon functional status and medical management after testing is not well characterized.
Methods: We prospectively enrolled outpatients without known CAD with stable chest pain syndrome to examine the impact of CCTA testing on functional status, including chest pain frequency, and CAD medication use.
Results: 63 patients (33% male, mean age 54±12) were enrolled, of whom 69% were hypertensive, 61% hyperlipidemic, 12% diabetic and 50% had a history of tobacco use. Patients rated their subjective chest pain frequency at a median of 3 to 6 times per week using the Seattle Angina Questionnaire (SAQ). The baseline Duke Activity Score Index (DASI) was 6.6±5. At baseline, 35% of the patients were taking aspirin, 24% statins, 29% beta blockers, 30% ACE inhibitors or ARBs, and 68% were taking any type of antihypertensive (median, 1 antihypertensive per individual). At a 30-day follow-up, a significant increase in functional status was observed, with 35.9% experiencing improvement by 1 or more metabolic equivalents (METs) [p=0.024]. Improvement sin functional status were accompanied by significant reductions in chest pain frequency (median 1–2 times per week, Wilcoxon rank sum p<0.001). Patients were more frequently taking aspirin and statins (mean difference for aspirin and statin 12.7%±38.1%, p=0.01; 19.0%±43.5%, p=0.001, respectively). While no difference in new prescriptions of individual classes of antihypertensive medications were observed, there was a significant augmentation in the absolute number of antihypertensives prescribed (Wilcoxon rank sum p=0.02). Changes in functional status, chest pain frequency and medication use remained significantly different even after exclusion of 3 patients who underwent coronary revascularization.
Conclusion: Improvements in functional status, chest pain frequency and CAD medication use occurs during near-term 30-day follow-up of individuals undergoing CCTA. These changes are evident even among patients who are not referred for coronary revascularization.